Provider Demographics
NPI:1942924493
Name:KITTLESON, SHELBY (MSW)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:KITTLESON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W MIDDLE ST STE H
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1647
Mailing Address - Country:US
Mailing Address - Phone:734-719-0197
Mailing Address - Fax:
Practice Address - Street 1:134 W MIDDLE ST STE H
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1647
Practice Address - Country:US
Practice Address - Phone:734-719-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511143771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical